Surgical stapling device with independent tip rotation

ABSTRACT

A surgical stapling device is disclosed which includes a handle assembly, an endoscopic body portion and a tool assembly. The tool assembly is rotatably and pivotally supported on a distal end of the endoscopic body portion. A tool assembly rotation mechanism is provided which includes a rotation knob, a substantially rigid tube and a flexible member interconnecting the rigid tube to the tool assembly. The substantially rigid tube translates rotation of the rotation knob to rotation of the flexible member and provides a channel for passage of other components of the surgical stapling device.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/847,791, filed Mar. 20, 2013, now U.S. Pat. No. 9,498,212, which is acontinuation of U.S. patent application Ser. No. 13/233,299, filed Sep.15, 2011, (now U.S. Pat. No. 8,424,739), which is a continuation of U.S.patent application Ser. No. 10/968,525, filed Oct. 18, 2004, (now U.S.Pat. No. 8,770,459), which claims benefit of U.S. ProvisionalApplication Ser. No. 60/512,481 filed Oct. 17, 2003, and the disclosuresof each of the above-identified applications are hereby incorporated byreference in their entirety.

BACKGROUND

1. Technical Field

The present application relates to a surgical stapling device and, moreparticularly, to an endoscopic surgical stapling device having a toolassembly and an endoscopic body portion, wherein the tool assembly isrotatable independently of the endoscopic body portion.

2. Background of Related Art

Surgical devices having a tool assembly for grasping or clamping tissuebetween opposing jaw structure and then joining the tissue usingsurgical fasteners are well known in the art. In some such devices, aknife is provided to cut the tissue which has been joined by thefasteners. The fasteners are typically in the form of surgical staplesalthough two part fasteners are also well known.

The above-described surgical devices typically include two elongated jawmembers which are movable with respect to each other to capture or clamptissue. One of the members carries a staple cartridge which houses aplurality of staples arranged, for example, in at least two lateral rowswhile the other member has an anvil that defines a surface for formingstaple legs as the staples are driven from the staple cartridge.Generally, the stapling operation is effected by cam members that travellongitudinally through the staple cartridge, such that the cam membersengage staple pushers to sequentially eject the staples from the staplecartridge. A knife can travel between the staple rows to longitudinallycut the stapled tissue between the rows of staples. Examples of knownsurgical stapling devices of this type are disclosed in U.S. Pat. Nos.5,478,003, 6,250,532 and 6,241,139 which are incorporated herein byreference in their entirety.

In endoscopic or laparoscopic procedures, surgery is performed throughsmall incisions or through small diameter cannulas inserted throughsmall entrance wounds in the skin. Due to the limited degree ofmaneuverability of a stapling device when it is positioned through theskin or a cannula, it can be difficult for a surgeon to manipulate thetool assembly of the instrument to access and/or clamp tissue. Toovercome this problem, instruments having rotatable endoscopic bodyportions and rotatable and/or articulatable tool assemblies have beendeveloped and are commercially available. Although these instrumentsprovide significant improvements in the endoscopic tool art, furtherimprovements that may decrease the time required for surgical proceduresby allowing surgeons to more quickly access tissue are desired.

U.S. Pat. No. 5,478,003 (“'003 patent”) discloses a surgical staplingdevice having a handle assembly, an elongated body portion and afastener applying assembly. A first control mechanism is provided forrotating the elongated body and fastener applying assembly about thelongitudinal axis of the elongated body portion. A second controlmechanism is provided for articulating the fastener applying assemblyabout an axis substantially perpendicular to the longitudinal axis. Athird control mechanism is provided for controlling independent rotationof the fastener applying assembly. Independent rotation of the fastenerapplying assembly is effected by a planetary gear assembly which drivesa transmission axle and a flexible coupling. During operation of thethird control mechanism, the fastener applying assembly has a tendencyto lag behind operation of the control actuator. Although the staplingdevice disclosed in the '003 patent facilitates faster and easier accessto the surgical site, a less complex more responsive surgical staplingdevice is desirable.

Accordingly, a continuing need exists in the art for a less complexendoscopic instrument having a tool assembly which is remotelypositionable about multiple axes and is substantially directlyresponsive to operation of the control mechanism.

SUMMARY

In accordance with the present disclosure, a surgical stapling device isdisclosed which includes a handle assembly, an endoscopic body portionand a tool assembly. The endoscopic body portion is rotatably secured tothe handle assembly and defines a first longitudinal axis. The toolassembly defines a second longitudinal axis and is rotatably andpivotally supported on a distal end of the endoscopic body portion. Thetool assembly is pivotal about an axis substantially perpendicular tothe first longitudinal axis and rotatable about the second longitudinalaxis. The surgical stapling device also includes a tool assemblyrotation mechanism including a substantially rigid tube which ispositioned within the endoscopic body portion and has a proximal endoperably connected to a rotation knob and a distal end operablyconnected to a tool assembly via a flexible member. The substantiallyrigid tube translates rotation of the rotation knob directly to theflexible member and provides a channel for passage of firing andretraction cables for operating the tool assembly. In one embodiment,the flexible member includes a flexible bellows. In another embodiment,the flexible member includes a coil spring.

In one embodiment, the tool assembly rotation mechanism includes a firstgear fixedly secured to the substantially rigid tube, a spacer tubepositioned about the substantially rigid tube, a second gear rotatablysupported on the spacer tube and engaged with the first gear, and arotation knob including internal gear teeth positioned in engagementwith the second gear. When the rotation knob is operated, e.g., rotated,the internal gear teeth of the rotation knob effects rotation of thesecond gear. Rotation of the second gear is translated into rotation ofthe first gear and, thus, rotation of the substantially rigid tube.

The presently disclosed surgical stapling device also includes anactuation member which is movable in relation to the tool assembly toactuate the tool assembly. The actuation member is operably connected tothe handle assembly by firing and retraction cables such that movementof the operating trigger of the handle assembly effects advancement andretraction of the actuation member.

In one embodiment, the tool assembly includes a cartridge assembly forhousing a plurality of staples and an anvil assembly. The anvil assemblyis movable in relation to the cartridge assembly between spaced andapproximated positions. It is also envisioned that the tool assembly maybe other than a surgical stapling device. For example, the tool assemblymay include graspers, dissectors, RF sealing devices, etc.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the presently disclosed surgical stapling deviceare described herein with reference to the drawings; wherein:

FIG. 1 is a side perspective view from the distal end of the presentlydisclosed surgical stapling device with the tool assembly in the openposition;

FIG. 2 is a side view of the surgical stapling device shown in FIG. 1;

FIG. 3 is a top view of the surgical stapling device shown in FIG. 1;

FIG. 4 is a side perspective view from the proximal end of the handleassembly and proximal portion of the endoscopic body portion with ahandle half-section removed;

FIG. 5 is a side perspective view from above of the handle assembly andproximal portion of the endoscopic body portion with a handlehalf-section removed;

FIG. 6 is a side view of the handle assembly and proximal portion of theendoscopic body portion shown in FIG. 5;

FIG. 6A is a cross-sectional view of the proximal portion of theendoscopic body portion and the distal end of the handle assemblyincluding the tool assembly rotation knob and the body rotation knob;

FIG. 7 is a cross-sectional view taken along section lines 7-7 of FIG.6;

FIG. 8 is a cross-sectional view taken along section lines 8-8 of FIG.6;

FIG. 9 is a perspective view with parts separated of the surgicalstapling device shown in FIG. 1;

FIG. 10 is a side perspective view from the distal end of the spindleand barrel assembly of the surgical stapling device shown in FIG. 1;

FIG. 11 is a perspective view from the distal end with parts separatedof the spindle and barrel assembly shown in FIG. 10;

FIG. 11A is a side perspective view from the proximal end of the firingtrigger and first shift ring assembly of the surgical stapling deviceshown in FIG. 1;

FIG. 11B is a side perspective view from the proximal end with partsseparate of the firing trigger and first shift ring assembly shown inFIG. 11A;

FIG. 11C is a side partial phantom view of the firing trigger and firstshift ring assembly shown in FIG. 11A with the first shift ring assemblyin its advanced position;

FIG. 11D is a side partial phantom view of the firing trigger and firstshift ring assembly shown in FIG. 11C with the selector switch moved tomove the first shift ring assembly to its retracted position;

FIG. 12 is a top perspective view of the spindle shown in FIG. 11;

FIG. 13 is an enlarged view of the indicated area of detail shown inFIG. 12;

FIG. 14 is an enlarged view of the indicated area of detail shown inFIG. 12;

FIG. 15 is a side perspective from the distal end of the body portion ofthe barrel assembly shown in FIG. 11;

FIG. 16 is an enlarged view of the indicated area of detail shown inFIG. 17;

FIG. 17 is a side perspective view from the proximal end of the bodyportion of the barrel assembly shown in FIG. 15;

FIG. 18 is a side perspective view of the retraction pawl of the barrelassembly shown in FIG. 10;

FIG. 19 is a side perspective view from the proximal end of the innerring of the first shift ring assembly of the barrel assembly shown inFIG. 10;

FIG. 20 is a side perspective view of one half-section of the outer ringof the second shift ring assembly of the barrel assembly shown in FIG.10;

FIG. 21 is a side perspective view of one half-section of the outer ringof the first shift ring assembly of the barrel assembly shown in FIG.10;

FIG. 22 is a side perspective view with parts separated of thearticulation mechanism of the surgical stapling device shown in FIG. 1;

FIG. 23 is a top partial phantom view of the articulation mechanismshown in FIG. 22 in the non-articulated position;

FIG. 24 is a top partial phantom view of the articulation mechanismshown in FIG. 22 in an articulated position;

FIG. 25 is a side perspective partial cutaway view from the distal endof the proximal end of the endoscopic body portion and the distal end ofthe handle assembly with a half-section of the rotation knob and thearticulation lever removed;

FIG. 26 is a side perspective view from the proximal end of theendoscopic body portion and the distal end of the handle assembly withthe outer tube, the spacer tube and a half-section of the rotation knoband the articulation lever removed;

FIG. 27 is a cross-sectional view from the bottom of the distal end ofthe endoscopic body portion and the proximal end of the tool assemblywith the tool assembly in a non-articulated position;

FIG. 28 is a cross-sectional view from the bottom of the distal end ofthe endoscopic body and the proximal end of the tool assembly with thetool assembly articulated ninety degrees;

FIG. 29 is a side perspective view from the proximal end of the surgicalstapling device shown in FIG. 1 with the tool assembly articulatedninety degrees and a distal portion of the outer tube of the endoscopicbody portion cutaway;

FIG. 30 is an enlarged view of the indicated area of detail shown inFIG. 29;

FIG. 31 is a cross-sectional view taken along section lines 31-31 ofFIG. 6;

FIG. 32 is a side perspective view from the distal end of the distal endof the endoscopic body portion and the tool assembly of the surgicalstapling device shown in FIG. 1 with the tool assembly articulatedninety degrees;

FIG. 33 is a side perspective view of the distal end of the endoscopicbody portion and the tool assembly shown in FIG. 32 with the toolassembly in the non-articulated position;

FIG. 33A is a cross-sectional view taken along section lines 33A-33A ofFIG. 33;

FIG. 34 is a side perspective view of the distal end of the endoscopicbody portion and tool assembly shown in FIG. 33 with the outer tuberemoved;

FIG. 35 is a side perspective view of the distal end of the endoscopicbody portion and tool assembly shown in FIG. 34 with the spacer tuberemoved;

FIG. 36 is a side perspective view from the distal end with partsseparated of the tool assembly and rotation collar of the surgicalstapling device shown in FIG. 1;

FIG. 37 is a top perspective view from the proximal end of the anvilbody portion of the tool assembly shown in FIG. 36;

FIG. 38 is a side perspective view from the proximal end of the dynamicclamping member of the tool assembly shown in FIG. 36 with the firingcable and retraction cable positioned about the dynamic clamping member;

FIG. 39 is a side perspective view from the distal end of the dynamicclamping member shown in FIG. 38;

FIG. 40 is a side perspective view of the torque transmitting member ofthe tool assembly shown in FIG. 36;

FIG. 41 is a side view of the torque transmitting member shown in FIG.40;

FIG. 42 is a side view of the torque transmitting member shown in FIG.41 in a slightly bent configuration;

FIG. 43 is a side cross-sectional view of the distal end of theendoscopic body portion and tool assembly of the surgical staplingdevice shown in FIG. 1 through a cam surface of the drive sled;

FIG. 44 is an enlarged view of the indicated area of detail shown inFIG. 43;

FIG. 45 is a side cross-sectional view of the distal end of theendoscopic body portion and tool assembly shown in FIG. 43 through a legof one row of staples;

FIG. 46 is a side cross-sectional view of the distal end of theendoscopic body portion and tool assembly shown in FIG. 45 through thedynamic clamping member;

FIG. 47 is a top view of the anvil assembly of the surgical staplingdevice shown in FIG. 1 with the retraction and firing cables positionedabout the dynamic clamping member;

FIG. 48 is a top view of the anvil assembly shown in FIG. 47 with theanvil plate removed;

FIG. 49 is a side view of the handle assembly and proximal portion ofthe endoscopic body portion of the surgical stapling device shown inFIG. 1 with the grasper button moved to the forward position;

FIG. 50 is an enlarged cross-sectional view taken along section lines50-50 of FIG. 49 of the spindle and barrel assembly;

FIG. 51 is a cross-sectional view of the handle assembly and proximalportion of the endoscopic body portion shown in FIG. 49 with the firingtrigger actuated in the grasper mode;

FIG. 52 is a side view of the distal end of the surgical stapling deviceshown in FIG. 1 with the tool assembly shown in the open position and inphantom in the closed position;

FIG. 53 is an enlarged view of the indicated area of detail shown inFIG. 51;

FIG. 54 is a cross-sectional view taken along section lines 54-54 ofFIG. 53;

FIG. 55 is an enlarged view of the indicated area of detail shown inFIG. 51;

FIG. 56 is a side view of the handle assembly and proximal portion ofthe endoscopic body portion of the surgical stapling device with thegrasper button moved to the retracted position;

FIG. 57 is a side cross-sectional view of the spindle and barrelassembly shown in FIG. 50 with the first shift ring assembly in theadvanced position;

FIG. 58 is a top cross-sectional view of the spindle and barrel assemblyshown in FIG. 57;

FIG. 59 is an enlarged view of the indicated area of detail shown inFIG. 57;

FIG. 60 is an enlarged view of the indicated area of detail shown inFIG. 59;

FIG. 61 is an enlarged view of the indicated area of detail shown inFIG. 57;

FIG. 62 is a cross-sectional view taken along section line 62-62 of FIG.61;

FIG. 63 is a cross-sectional view taken along section line 63-63 of FIG.61;

FIG. 64 is a side cross-sectional view of the spindle and barrelassembly shown in FIG. 61 during movement of the firing trigger to thenon-compressed position and movement of the barrel assembly distallyabout the spindle;

FIG. 65 is a side cross-sectional view of the handle assembly of thesurgical stapling device shown in FIG. 1 with the first shift ringassembly in the advanced position, and the firing trigger moved throughone actuation stroke returned to the non-compressed position;

FIG. 66 is a side view of the tool assembly shown in FIG. 52 moved tothe closed position;

FIG. 67 is a side cross-sectional view of the handle assembly shown inFIG. 65 after the device has been fired with the indicator member in thefully advanced position;

FIG. 68 is a side cross-sectional view of the handle assembly shown inFIG. 67 with the selector switch moved to move the first shift ringassembly to its retracted position;

FIG. 69 is enlarged view of the indicated area of detail shown in FIG.68;

FIG. 70 is an enlarged view of the indicated area of detail shown inFIG. 68; and

FIG. 71 is an enlarged side cross-sectional view of the spindle andbarrel assembly shown in FIG. 68 with the retraction pawl engaged in theretraction rack.

DETAILED DESCRIPTION OF EMBODIMENTS

Embodiments of the presently disclosed surgical stapling device will nowbe described in detail with reference to the drawings in which likereference numerals designate identical or corresponding elements in eachof the several views.

FIGS. 1-3 illustrate one embodiment of the presently disclosed surgicalstapling device shown generally as 10. Briefly, surgical stapling device10 includes a handle assembly 12, an endoscopic body portion 14 and atool assembly 16. Handle assembly 12 includes a stationary handleportion 18 and a firing or operating trigger 20. A grasper button 22 ismovably positioned on handle assembly 12 adjacent stationary handleportion 18. A body rotation knob 24 is rotatably supported adjacent adistal end of handle assembly 12 and a tool assembly rotation knob 26 isrotatably supported adjacent the distal end of rotation knob 18.Rotation knob 24 may be formed from molded half-sections 24 a and 24 bwhich are secured together using any known fastening technique, e.g.,screws 25. An articulation lever 28 is pivotally supported on rotationknob. The function of each of the knobs and buttons will be discussed infurther detail below.

Referring to FIGS. 4-14, stationary handle portion 18 includeshalf-sections 18 a and 18 b (FIG. 9) which can be molded from athermoplastic material, e.g., polycarbonate. Alternately, other knownmaterials suitable for surgical use and having the requisite strengthcharacteristics may be used. Handle half-sections 18 a and 18 b aresecured together using a known fastening technique, e.g., adhesives,welding, screws, interlocking structure, etc.

Handle assembly 12 includes an approximation and firing mechanism whichincludes a spindle 30 (FIG. 12) which has diametrically opposed guidetracks 32 and 34 (FIG. 8). The proximal end of spindle 30 includes anextension 36 which defines an annular slot 38. Extension 36 is rotatablyreceived within a recess 40 (FIG. 4) formed in stationary handle portion18 to rotatably fasten spindle 30 within stationary handle portion 18. Awall 40 a defining recess 40 extends into slot 38 of spindle 30 toaxially fix spindle 30 within handle portion 18. A pinion 42 isrotatably fastened about a pin 43 within a throughbore 44 (FIG. 14)formed in spindle 30. Pinion 42 includes gear teeth 46 which extend intoguide tracks 32 and 34 of spindle 30.

A firing rack 48 is slidably received in guide track 32 of spindle 30and a retraction rack 50 is slidably received in guide track 34 ofspindle 30. Firing rack 48 includes gear teeth 52 and 54 formed onopposite sides of firing rack 48. Gear teeth 52 are positioned to engageteeth of an advancement and firing pawl 56 (“firing pawl”) and gearteeth 54 are positioned to engage the teeth of pinion 42. The proximalend of firing rack 48 includes a cutout 58 which is dimensioned toreceive an engagement member 60 a of a grasper pawl 60 in a manner to bediscussed in detail below. Retraction rack 50 also includes gear teeth62 and 64 formed on opposite sides thereof. Gear teeth 62 are positionedto engage the teeth of a retraction pawl 66 and gear teeth 64 arepositioned to engage teeth 46 of pinion 42. The proximal end ofretraction rack 50 includes a bore for receiving a pin 68 b (FIG. 11) ofan indicator ring 68. Indicator ring 68 is slidably positioned aboutspindle 30 and is secured to and movable with retraction rack 50. In oneembodiment, indicator ring 68 includes an indicator member 70 which issecured to indicator ring 68 and has a radial extension 70 a whichextends through and is movable within an elongated slot 72 formed inhandle portion 18. The location of extension 70 a along slot 72 providesa visual indication to a surgeon of the stage of operation of staplingdevice 10. The extension may be colored to facilitate viewing, e.g.,red. Alternately, a window or transparent portion (not shown) may beprovided in stationary handle portion 18 to facilitate direct viewing ofthe position of indicator ring 60 on spindle 30. Indicia may be providedon handle portion 18 adjacent the window or slot 72 to specify the stageof operation of the device (retracted, partially approximated, fullyapproximated, etc. . . . ) with reference to the position of indicatorring 68 on spindle 30. Either indicator ring 68 or indicator member 70may include a pair of diametrically opposed wings 68 a which areslidably received in guide slots 74 (FIG. 7) formed in each handlehalf-section 18 a and 18 b.

A barrel assembly 80 is slidably positioned about spindle 30. Barrelassembly 80 includes firing pawl 56, grasper pawl 60, retraction pawl66, a body portion 82, first and second shift ring assemblies 84 and 86,and a trigger connector 88. Barrel assembly body portion 82 (FIGS.16-18) includes a pair of axially spaced bores 90 and 92 (FIG. 11).Firing pawl 56 is pivotally secured within bore 90 about a pivot pin 94which extends through barrel assembly body portion 82. Retraction pawl66 is pivotally secured within an opposite side of throughbore 90 abouta pivot pin 96 which extends through barrel assembly body portion 82. Abiasing member or O-ring 98 a is positioned within an annular slot 82 ain body portion 82 of barrel assembly 82 about firing pawl 56 andretraction pawl 66 to urge firing pawl 56 and retraction pawl 66 intoengagement with firing rack 48 and retraction rack 50, respectively.Alternately, other biasing devices, e.g., coil springs, may be used tobias the firing pawl and retraction pawl into engagement with the firingand retraction racks, respectively. Firing pawl 56 includes a cam slot56 a, and series of teeth 56 b configured to engage teeth 52 of firingrack 48. Retraction pawl 66 includes a cam slot 66 a and a series ofteeth 66 b configured to engage teeth 62 of retraction rack 50.

Grasper pawl 60 is pivotally secured in one end of throughbore 92 abouta pivot pin 95 and includes a cam slot 60 a. A biasing member, e.g.,O-ring 98 b, is positioned within an annular slot 82 b (FIG. 61) in bodyportion 82 in engagement with grasper pawl 60 to urge engagement finger60 b of grasper pawl 60 into cutout 58 of firing rack 48. Operation ofgrasper pawl 60 will be discussed in further detail below.

First shift ring assembly 84 includes an outer ring 100 and an innerring 102. In one embodiment, outer ring 100 is formed from a pair ofhalf-sections 100 a and 100 b which can be fastened together using anyknown fastening technique, e.g., pins 103. Each half-section 100 a and100 b has a finger 104 extending distally therefrom. A projection or pin106 extends radially inwardly from each finger 104. Projections 106 maybe separate from or formed integrally with fingers 104 and aredimensioned to be received within cam slots 110 formed in a lever 108which will be discussed in further detail below. An inner surface ofouter ring 100 includes an annular rib 112.

Inner ring 102 includes an outer annular groove 114 dimensioned toreceive annular rib 112 of outer ring 100. Engagement between annularrib 112 and annular groove 114 prevents axial movement of outer ring 100in relation to inner ring 102 while permitting rotation of outer ring100 in relation to inner ring 102. A plurality of ridges 116 are formedalong an inner surface of inner ring 102. Ridges 116 are slidablyreceived in grooves 118 formed in body portion 82 of barrel assembly 80.Engagement between ridges 116 and grooves 118 rotatably fix inner ring102 to body portion 82 while permitting axial movement of inner ring 102in relation to body portion 82 of barrel assembly 80.

Inner ring 102 is positioned about body portion 82 of barrel assembly 80and outer ring 100 is positioned about inner ring 102. As discussedabove, inner ring 102 is axially slidable but rotatably fixed inrelation to body portion 82, and inner ring 102 is axially fixed butrotatable in relation to outer tube 100. A pair of cam members, e.g.,pins 120 and 122, extend from one side of inner ring 102 across an innerbore defined by inner ring 102 to the other side of inner ring 102.First cam member 120 extends through cam slot 56 a formed in firing pawl56 and second cam member 122 extends through cam slot 66 a of retractionpawl 66 (See FIG. 50). When outer ring 100 is moved axially betweenadvanced and retracted positions about body portion 82 of barrelassembly 80 by actuation of lever 108, as will be discussed in furtherdetail below, inner ring 102 is moved therewith to effect movement ofcam members 120 and 122 within cam slots 56 a and 66 a, respectively, offiring pawl 56 and retraction pawl 66, respectively. Cam slots 56 a and66 a are configured to allow O-ring 98 a to urge and position firingpawl 56 in engagement with firing rack 48 when outer ring 100 is movedby lever 108 to its advanced position and to allow O-ring 98 a toposition retraction pawl 66 in engagement with retraction rack 50 whenouter ring 100 is moved by lever 108 to its retracted position. Whenouter ring 100 and thus, inner ring 102, are in their advanced positionabout barrel assembly 80, cam member 122 is engaged with a surface ofcam slot 66 a to prevent engagement of retraction pawl 66 withretraction rack 50. When outer ring 100 and inner ring 102 are in theirretracted position about barrel assembly 80, cam member 120 is engagedwith a surface defining cam slot 56 a to prevent engagement betweenfiring pawl 56 and firing rack 48. Referring to FIG. 16, the outersurface of body portion 82 of barrel assembly 80 includes a plurality ofresilient nubs 81 which are received in openings 81 a (FIG. 60) formedin inner ring 102 to retain the inner ring 102 in its advanced orretracted position.

Referring to FIGS. 11-11D, lever 108 includes an arm 124 and a U-shapedcollar 126 which is positioned partially about body portion 82 of barrelassembly 80. Cam slots 110 are formed in opposite ends of U-shapedcollar 126 and slidably receive projections 106 of outer ring 100. Arm124 of lever 108 includes a pair of spaced body members 124 a and 124 bwhich define a channel 128 therebetween (FIG. 11). Body members 124 aand 124 b each include an elongated slot 130 formed on one end thereofand a bore 131 formed in an opposite end thereof. Pin 132 connects arm124 to the distal end of a link 134 and bore 131 receives a pivot pin131 a for pivotally securing lever 108 to an extension 20 a formed onfiring trigger 20. Link 134 is connected to or, formed monolithicallywith a selector switch 136 which is slidably supported on firing trigger20. Selector switch 136 is positioned on firing trigger 20 such that itcan be engaged from either side or the back of firing trigger 20.

When selector switch 136 is slid along firing trigger 20 in thedirection indicated by arrow “A” in FIG. 6, lever 108 is pivoted aboutpivot pin 131 a to move U-shaped collar 126 proximally about bodyportion 82 of barrel assembly 80. Movement of U-shaped collar 126proximally effects movement of outer ring 100 about body portion 82 ofbarrel assembly 80 proximally, via projections 106, to move inner ring102 of first shift ring 84 proximally from its advanced position to itsretracted position. As discussed above, when inner ring 102 is moved toits retracted position, retraction pawl 66 is urged into engagement withretraction rack 50 by O-ring 98 a and firing pawl 56 is pivoted fromengagement with firing rack 48 against the bias of O-ring 98 a by cammember 120.

Second shift ring assembly 86 includes an outer ring 140 and an innerring 142. In one embodiment, outer ring 140 is formed from a pair ofhalf-sections 140 a and 140 b which can be fastened together using knownfastening techniques, e.g., pins 144. Each half-section 140 a and 140 bhas a post 146 extending radially outwardly therefrom. Posts 146 aredimensioned to extend through respective slots 148 (FIG. 1) formed instationary handle portion 18 and support a respective grasper button 22.An inner surface of outer ring 140 includes an annular rib 148.

Inner ring 142 includes an outer annular groove 150 dimensioned toreceive annular rib 148 of outer ring 140. Engagement between annularrib 148 and annular groove 150 prevents axial movement of outer ring 140in relation to inner ring 142 while permitting rotation of outer ring140 in relation to inner ring 142. A plurality of ridges 152 are formedalong an inner surface of inner ring 142. Ridges 152 are slidablyreceived in grooves 118 formed in body portion 82 of barrel assembly 80.Engagement between ridges 152 and grooves 118 rotatably fix inner ring142 to body portion 82 while permitting axial movement of inner ring 142in relation to body portion 82.

Inner ring 142 is positioned about body portion 82 of barrel assembly 80and outer ring 140 is positioned about inner ring 142. As discussedabove, inner ring 142 is axially slidable but rotatably fixed inrelation to body portion 82, and inner ring 142 is axially fixed butrotatable in relation to outer ring 140. A cam member, e.g., a rod orpin 154, extends from one side of inner ring 142 across an inner boredefined by inner ring 142 to an opposite side of inner ring 142. Cammember 154 extends through a cam slot 60 a formed in grasper pawl 60.Inner ring 142 is axially movable along an outer surface of body portion82 of barrel assembly 80 from an advanced position to a retractedposition, via manual movement of grasper button 22, to move cam member154 within cam slot 60 a of grasper pawl 60. When inner ring 142 ismoved to its retracted position, cam member 154 is engaged with a wallor surface defining cam slot 60 a to urge grasper pawl 60 out ofengagement with firing rack 48 against the bias of O-ring 98 b. Wheninner ring 142 is in its advanced position, cam member 154, incombination with O-ring 98 b, urges grasper pawl into engagement withfiring rack 48. Openings 142 a formed in inner ring 142 receive nubs 81formed on barrel assembly body portion 82 to releaseably retain innerring 142 in its respective advanced and retracted positions (FIG. 69).

Referring to FIG. 11, barrel assembly 80 also includes a triggerconnector 88 which includes an annular member 160 rotatably securedabout a distal end of barrel assembly body portion 82 by a cap or ring162. Cap 162 can be secured to the distal end of barrel assembly bodyportion 82 by a pair of pins 164 such that annular member 160 issupported on the distal end of barrel assembly body portion 82 betweencap 162 and a shoulder 166 of barrel assembly body portion 82. Pins 164extend through grooves 165 formed in body portion 82 of barrel assembly80. Alternately, other fastening techniques may be used to secure thecap to the barrel assembly body portion, e.g., screw threads, adhesives,welding, etc. Annular member 160 includes a pair of prongs 168positioned and configured to engage firing trigger 20 in a manner to bedescribed below.

Referring to FIGS. 11A-11D, firing trigger 20 includes a grip portion170, an engagement portion 172 and a pivot portion 174. Pivot portion174 is formed at a top end of firing trigger 20 and is configured to bepivotally secured between handle half-sections 18 a and 18 b about apivot member 176 (FIG. 5). Engagement portion 172 of firing trigger 20includes a cylindrical member 178 positioned about body portion 82 ofbarrel assembly 80 and a pair of U-shaped hook members 180. Hook members180 are dimensioned to slidably receive prongs 168 of annular member 160(FIG. 11) such that pivotal movement of firing trigger 20 about pivotmember 176 is translated to linear movement of barrel assembly 80 aboutspindle 30.

Referring to FIG. 9, a biasing mechanism 182 includes a hollowcylindrical member 184, a cylindrical rod 186 telescopingly receivedwithin hollow cylindrical member 184 and a coil spring 188 positionedbetween cylindrical member 184 and cylindrical rod 186. Cylindricalmember 184 has a first end 189 pivotally secured to firing trigger 20about a pivot pin 190 (FIG. 4). Cylindrical rod 186 is pivotally securedbetween handle half-sections 18 a and 18 b about a pivot pin 192 (FIG.4). Coil spring 188 is positioned between cylindrical member 184 andcylindrical rod 186 to urge member 184 and rod 186 apart and thus, urgefiring trigger 20 to a non-actuated or non-compressed position.

In use, when trigger 20 is manually pivoted towards stationary handle 18in the direction indicated by arrow “X” in FIG. 6, barrel assembly 80 ismoved proximally over spindle 30 in the direction indicated by arrow“Y”. If first shift ring assembly 84 is in its advanced position, i.e.,positioned such that firing pawl 56 is engaged with firing rack 48,firing rack 48 is pushed proximally along guide track 32. As thisoccurs, pinion 42, which is engaged with firing rack 48 and retractionrack 50, will rotate and advance retraction rack 50 along guide track34. If first shift ring assembly 84 is in its retracted position, i.e.,positioned such that retraction pawl 66 is engaged with retraction rack50, retraction rack 50 will be pushed proximally along guide track 34 asbarrel assembly 80 is moved proximally by firing trigger 20 over spindle30. As this occurs, pinion 42 is driven by movement of retraction rack50 to advance firing rack 48 distally.

Referring to FIGS. 4-6, 9 and 55, handle assembly 12 includes a lockoutmechanism 500 which includes a lever 502, a drive member 504 and abiasing member 506. Lever 502 is pivotally mounted in proximal portionof handle assembly 12 between handle half-sections 18 a and 18 b about apivot member 508. A curved cam channel 510 is formed along one end oflever 502 and an abutment or stop member 509 is formed on an oppositeend thereof. Drive member 504 is slidable between linear guide members512 formed on an inner wall of handle half-sections 18 a and 18 b. Afirst end of drive member 504 is positioned adjacent barrel body portion82. A cam member 514 formed on a second end of drive member 504 isslidably positioned in cam channel 510. A biasing member, e.g., a coilspring 506, is positioned to urge drive member 504 to a distal position.

In use, when firing trigger 20 is compressed to drive barrel assembly 80proximally, body portion 82 of barrel assembly 80 moves drive member 504proximally against the bias of spring 506 to move cam member 514 throughcam channel 510 of lever 502. Because drive member 504 is confined tolinear movement and cam channel 510 is not linear, cam member 514 causeslever 502 to pivot about pivot member 508 such that stop member 509 ismoved to a position obstructing distal movement of indicator 68 aboutspindle 30 (FIG. 55). When stop member 509 engages indicator 68, furthercompression or actuation of firing trigger 20 is prevented and firingtrigger 20 must be released.

Lever 502 and cam channel 510 are positioned and configured to obstructmovement of indicator 68, and thus, prevent further actuation of thedevice, at a point at which tool assembly 16 has been approximated. Inorder to further actuate, i.e., fire, stapling device 10 after lockoutmechanism 500 is engaged, firing trigger 20 must be released to returndrive member 504 and lever 502 to their original positions. Sinceindicator 68 does not return to its original position when firingtrigger 20 is released, upon further actuation of firing trigger 20,indicator 68 is able to pass by stop member 509 before it is moved to aposition obstructing indicator movement.

Referring to FIGS. 6, 6A and 9, body rotation knob 24 can be formed froma thermoplastic material, e.g., polycarbonate, and includeshalf-sections 24 a and 24 b which together define an annular recess 194.Stationary handle portion 18, including half-sections 18 a and 18 b,includes a distal extension 198 having an annular flange 200. Annularflange 200 is rotatably received within annular recess 194 of bodyrotation knob 24 to rotatably secure and axially fix rotation knob 24 tostationary handle portion 18. A proximal portion of body rotation knob24 includes an annular array of flutes 202 which facilitate grasping androtation of knob 24.

The proximal end of an outer tube 204 of endoscopic body portion 14includes an annular flange 206 which is rotatably received within anannular recess 196 formed in extension 198 of handle portion 18 (FIG.6A). A pair of tabs 197 are formed on an inner surface of rotation knob24 and are received in openings 199 (FIG. 9) in outer tube 204 to secureouter tube 204 to rotation knob 24. Accordingly, when body rotation knob24 is rotated about a longitudinal axis of endoscopic body portion 14 inrelation to stationary handle portion 18, rotation of outer tube 204 isalso effected.

Referring to FIG. 9, endoscopic body portion 14 includes outer tube 204,a spacer tube 210 including half-sections 210 a and 210 b, a rotatableinner tube 212 and an arcuate articulation link 214. Articulation link214 forms part of an articulation mechanism which will be described indetail below. Articulation link 214 has a distal end 214 a connected toan articulation arm 215 (FIG. 36) and a proximal end 214 b connected toother components of the articulation mechanism as will be describedbelow. Spacer tube 210 is positioned within outer tube 204 and includesa longitudinal cutout which defines a channel 216 with outer tube 204for slidably receiving articulation link 214 (See FIG. 33A).

Referring to FIGS. 22-24, the articulation mechanism includesarticulation lever 28, a rotatable link 220, a cam plate 222 andarticulation link 214. Rotatable link 220 includes a first link member220 a, a second link member 220 b and a pin or post 220 c. Post 220 chas a first end fixedly connected to first link member 220 a and asecond end fixedly connected to second link member 220 b. First linkmember 220 a is secured to a base portion 28 a of lever 28 by a pair ofpins 224. Post 220 c extends through an opening 226 (FIG. 9) formed inbody rotation knob 24 such that lever 28 and first link member 220 a arerotatably positioned on a flat surface 230 of body rotation knob 24(FIG. 9) and second link member 220 b is rotatably positioned withinbody rotation knob 24. Second link member 220 b is pivotally connectedto cam plate 222 via a first connector 232. First connector 232 includesa first pin member 232 a which is pivotally received within a bore 234formed in second link member 220 b and a second pin member 232 b whichis slidably positioned within a cam slot 222 a formed in cam plate 222.A second connector 236 is rotatably connected to cam plate 222 via hole222 b and pivotally connected to the proximal end of articulation link214 b. Cam plate 222 is positioned within a recess 238 (FIG. 9) of bodyrotation knob 24. Recess 238 confines cam plate 222 to linear movementtherein.

In use, when lever 28 is pivoted about an axis “Y” (FIG. 22) defined bypost 220 c of rotatable link 220 in the direction indicated by arrow “C”in FIG. 24, first and second link members 220 a and 220 b are pivotedabout axis Y. As second link member 220 b pivots, second pin member 232b of connector 232 engages a wall defining cam slot 222 a of cam plate222 to move cam plate 222 linearly in the direction indicated by arrow“D” in FIG. 24 within recess 238 of body rotation knob 24. This linearmovement of cam plate 222 is translated to linear movement ofarticulation link 214 via second connector 236. The distal end 214 a ofarticulation link 214 is operably connected to articulation arm 215(FIG. 36), in a manner to be discussed in further detail below, suchthat linear movement of articulation link 214 effects articulation oftool assembly 16.

Referring to FIGS. 25 and 26, surface 230 of body rotation knob 24 caninclude a plurality of recesses 240 dimensioned to releasably receive anabutment 242 (FIG. 53) formed on a bottom surface of lever 28.Engagement between articulation lever abutment 242 and any one ofrecesses 240 retains the tool assembly at a pre-selected angle ofarticulation. In one embodiment, recesses 240 are provided to retaintool assembly 16 at angles of articulation of approximately 15.degree.,30.degree., 45.degree., 60.degree., 75.degree., and 90.degree.Alternately, recesses 240 may be provided to retain the tool assembly atany other desired angle(s) of articulation.

Referring to FIGS. 9 and 25-35, endoscopic body portion 14, as discussedabove, includes an inner rotatable tube 212 and a spacer tube 210. Afirst gear 252 is non-rotatably secured to the proximal end of innertube 212. In one embodiment, the proximal end of inner tube 212 has atleast one slot 250 formed therein, and gear 252 has an inner rib 254(FIG. 31) which is received within slot 250 to rotatably fix gear 252 toinner tube 212. Alternately, gear 252 may be secured to inner tube usingother known fastening techniques, e.g., set screws, welding, brazing,crimping, etc. A second gear 256 is rotatably supported on half-section210 a of spacer tube 210 adjacent an opening 258 formed in spacer tube210. Gear 256 extends through opening 258 and meshes with gear 252.

Referring also to FIGS. 6A and 31, tool assembly rotation knob 26includes an annular channel 26 a which is dimensioned to receive anannular rib 260 formed on body rotation knob 24 to rotatably secure knob26 to knob 24 about outer tube 204. The internal surface of toolassembly rotation knob 26 includes gear teeth 262 which also mesh withgear 256 through an opening 264 in outer tube 204 (FIG. 31). As such,when tool assembly rotation knob 26 is rotated about outer tube 204 inrelation to body rotation knob 24, gears 256 and 252 are driven orrotated. Since inner tube 212 is rotatably fixed to gear 252, inner tube212 rotates with gear 252. The distal end of inner tube 212 is operablyconnected to tool assembly 16 in a manner to be discussed below suchthat rotation of inner tube 212 is translated into rotation of toolassembly 16.

Referring to FIGS. 36-48, tool assembly 16 includes an anvil assembly300, a cartridge assembly 302, a torque transmitting member 304, arotation collar 306, a drive member 308 and a dynamic clamping oractuation member 309. Anvil assembly 300 includes a body portion 310 andan anvil plate 312 having a plurality of staple forming depressions 314(FIG. 45). The proximal end of anvil body portion 310 includes acylindrical extension 316 having an annular groove or channel 318 formedtherein. Rotation collar 306 defines a cylindrical bore 320 (FIG. 36)for receiving cylindrical extension 316 of anvil body portion 310. Apair of pins 322 extend through holes 324 in rotation collar 306 andinto annular channel 318 of cylindrical extension 316 of anvil bodyportion 310 to rotatably secure anvil body portion 310 to rotationcollar 306. Anvil body portion 310 also includes a pair of spaced tissuestops 326.

Cartridge assembly 302 includes a channel support member 330, a staplecartridge 332, a plurality of staples 334, a plurality of pushers 336associated with staples 334 and a drive sled 338. Staple cartridge 332is supported within channel support member 330 and can include aplurality of linear rows of staple receiving pockets 340. In oneembodiment, staple cartridge 332 includes six linear rows of staplereceiving pockets 340 although other staple pocket configurations andpatterns are envisioned. Each staple receiving pocket 340 slidablyreceives a staple 334 and a pusher 336 or a portion of a pusher 336.Staple cartridge 332 includes channels 342 for facilitating translationof sled 338 through staple cartridge 332. Sled 338 includes cam surfaces338 a for engaging pushers 336 and driving staples 334 from staplecartridge 332. Staple cartridge 332 also includes a central longitudinalslot 344 for allowing translation of dynamic clamping member 309 throughstaple cartridge 332. Sled 338 is positioned distally of clamping member309 and is engaged and driven by clamping member 309 after the anvil andcartridge assemblies have been approximated.

Dynamic clamping member 309 includes an upper flange portion 309 a, acentral body portion 309 b and a lower flange portion 309 c. Upperflange portion 309 a is positioned to slide along an upper surface ofanvil body portion 310. In one embodiment, an elongated recess 346 isprovided in anvil body portion 310 to accommodate upper flange portion309 a. A knife blade 348 formed in, or supported by central body portion309 b is positioned between upper and lower flange portions 309 a and309 c. An elongated slot 350 a is formed in anvil plate 312 tofacilitate passage of dynamic clamping member 309 through anvil assembly300. Lower flange portion 309 c is positioned to translate or slidealong a bottom surface 330 a (FIG. 45) of channel support member 330 ofcartridge assembly 302. By engaging surfaces of both the anvil assembly300 and cartridge assembly 302, dynamic clamping member 309 limitsdeflection and/or bowing of the anvil and cartridge assemblies anddefines a maximum tissue gap of tool assembly 16.

Referring to FIG. 36, cartridge assembly 302 is pivotally secured toanvil assembly 300 by pivot pins 348. Pivot pins 348 extend throughopenings 350 formed in anvil body portion 310 and into openings 352formed in channel support member 330. Cartridge assembly 302 is pivotalin relation to anvil assembly 300 from an open position spaced fromanvil assembly 300 (FIG. 45) to an approximated position in juxtaposedalignment with anvil assembly 300 (FIG. 46).

Referring to FIGS. 40-46, torque transmitting member 304 includes ahollow flexible member. In one embodiment, torque transmitting member304 includes a bellows which is constructed from a flexible materialcapable of transmitting torque, e.g., stainless steel, Nitinol™, nickel,etc. Alternately, torque transmitting member 304 may be formed of othermaterials including plastics. As shown in FIGS. 27 and 28, torquetransmitting member 304 may also comprise a coil spring or the like. Theproximal end 304 a of torque member 304 is fixedly secured to the distalend of inner tube 212 such as by welding or brazing. The distal end oftorque transmitting member 304 is secured to drive member 308. Drivemember 308 is positioned within a bore 360 (FIG. 37) of cylindricalextension 316 of anvil body portion 310. Drive member 308 includes apair of cutouts 308 a which engage tabs 360 a formed along a walldefining bore 360. Engagement between tabs 360 a and cutouts 308 arotatably fixes drive member 308 to anvil body portion 310.

In operation, when inner tube 212 is rotated by rotating tool assemblyrotation knob 26 in the manner discussed above, torque transmittingmember 304 is rotated to effect rotation of anvil body portion 310.Since anvil body portion 310 is rotatably mounted on rotation collar 306and cartridge assembly 302 is pivotally supported on anvil body portion310, rotation of anvil body portion 310 effects rotation of the entiretool assembly 316 independently of endoscopic body portion 14.

Referring to FIGS. 27-30 and 36, the proximal portion of rotation collar306 includes a clevis 370 having screw holes 372. A pair of bracketmembers 374 are secured at one end to clevis 370 by pivot members 376which allow collar 306, and thus, tool assembly 16, to pivot orarticulate thereabout. The other end of each bracket member 374 includesan opening 378 which receives a projection 378 a formed on spacer tube210 (FIG. 43) to secure collar 306 and tool assembly 16 to the distalend of endoscopic body portion 14. Outer tube 204 is positioned aboutspacer tube 210 and bracket members 374 to prevent separation of theparts. Articulation arm 215 has a distal end 215 a which is pivotallyconnected to rotation collar 306 by a pivot member or pin 380 at a pivotlocation 382 offset from the pivot axis defined by pivot members 376,i.e., the pivot axis of tool assembly 16. The proximal end 215 b ofarticulation arm 215 is pivotally secured to articulation link 214 by apivot pin 384.

In use, when articulation lever 28 is pivoted to move articulation link214 linearly within outer tube 204 in the manner discussed above,articulation arm 215 is also moved, i.e., advanced or retracted. Sincethe distal end of articulation arm 215 is pivotally connected torotation collar 306 at a position offset from pivot member 376, movementof articulation arm 215 effects articulation of rotation collar 306 andtool assembly 16 about the pivot axis defined by pivot member 376 (FIG.28). A slot 390 is provided in the distal end of outer tube 304 toaccommodate movement of articulation arm 215. Using this articulationmechanism, tool assembly 16 is pivotal to an angle of about 90.degree.in relation to the longitudinal axis of the endoscopic body portion 14of the device.

As illustrated in FIG. 28, torque transmitting member 304 is flexiblesuch that it will bend about the pivot axis of tool assembly 16. In itsbent condition, torque transmitting member 304 is still able totranslate rotation of inner tube 212 to rotation of tool assembly 16.

Referring to FIG. 36, a pair of rollers 400 a and 400 b are securedwithin the anvil assembly 300 between anvil body portion 310 and anvilplate 312. Rollers 400 a and 400 b include a central pivot member whichis rotatably received in openings 402 formed in anvil plate 312 andsimilar openings (not shown) formed in anvil body portion 310. Rollers400 form turnabouts for a cable drive system for approximating the anviland cartridge assemblies 300 and 302, respectively, and for ejectingstaples from staple cartridge 332. In addition to rollers, fixed pinsguideways, or the like can be employed.

Referring to FIGS. 6A and 43-48, the cable drive system of the presentlydisclosed stapling device 10 includes a firing cable 410 and aretraction cable 412. Firing cable 410 includes a first end 410 a and asecond end 410 b. Each end of firing cable 410 a and 410 b includes aloop which is secured within a slot 414 formed in the distal end offiring rack 48 by a pin 416 (FIG. 6A). Each end of firing cable 410extends distally from firing rack 48 through an opening 420 formed inthe distal end of spindle 30 into and through inner tube 212. Referringto FIG. 48, ends 410 a and 410 b of firing cable 410 extend from innertube 212, through torque transmitting member 304, drive member 308,rotation collar 306 and into anvil assembly 300. Ends 410 a and 410 bextend distally through spaced channels defined between anvil plate 312and anvil body portion 310 along opposite sides of anvil assembly 300,around rollers 400 a and 400 b, respectively, proximally through acenter channel 424 defined between anvil plate 312 and anvil bodyportion 310, and around dynamic clamping member 309 (FIG. 38). Dynamicclamping member 309 includes a rounded surface 426 to prevent wearing ofcable 410.

In use, when firing trigger 20 is compressed towards stationary handle18 and firing pawl 56 is engaged with firing rack 48, firing rack 48 ismoved proximally in the manner discussed above. As firing rack 48 movesproximally, both ends of firing cable 410 are pulled proximally toadvance dynamic clamping member 309 distally in relation to anvil andcartridge assemblies 300 and 302 to approximate the anvil and cartridgeassemblies 300 and 302. Sled 338 is positioned distally of dynamicclamping member 309 and is driven through staple cartridge 332 bydynamic clamping member 309 to sequentially eject staples 334 fromstaple cartridge 332.

Retraction cable 412 also includes a first end 412 a and a second end412 b. Each end 412 a and 412 b includes a loop which is secured withina slot 432 formed in the distal end of retraction rack 50 by a pin 434(FIG. 6A). Each end of retraction cable 412 extends distally fromretraction rack 50 through opening 420 in spindle 30 into and throughinner tube 212. Ends 412 a and 412 b of retraction cable 412 extend frominner tube 212, through torque transmitting member 304, drive member308, rotation collar 306 and cylindrical portion 316 of anvil bodyportion 310 to dynamic clamping member 309. A hole 436 is formed throughcentral body 309 b of dynamic clamping member 309. Cable 412 extendsthrough hole 436 to secure cable 412 to dynamic clamping member 309(FIG. 38).

In use, when firing trigger 20 is compressed towards stationary handle18 and retraction pawl 66 is engaged with retraction rack 50, retractionrack 50 is moved proximally in the manner discussed above. As retractionrack 50 moves proximally, both ends of retraction cable 412 are pulledproximally to pull cable 412 and dynamic clamping member 309 proximallyin relation to anvil and cartridge assemblies 300 and 302, respectively.Movement of dynamic clamping member 309 proximally allows the anvil andcartridge assemblies to move to the spaced position.

Operation of surgical stapling device 10 will now be described withreference to FIGS. 49-71. FIGS. 49-55 illustrate surgical staplingdevice 10 in the grasper mode. In the grasper mode, firing trigger 20can be actuated or compressed towards stationary handle portion 18 toapproximate anvil and cartridge assemblies 300 and 302. Device 10 willnot fire in the grasper mode. To place stapling device 10 in the graspermode, grasper button(s) 22 are pushed forward along stationary housing18 in the direction indicated by arrow “E” in FIGS. 49 and 50 to moveinner ring 142 of the second shift ring assembly to its advancedposition. As inner ring 142 is advanced, cam member 154 moves within camslot 60 a to pivot grasper pawl 60 in the direction indicated by arrow“F” in FIG. 50 to position engagement finger 60 b of grasper pawl 60into cutout 58 of firing rack 48. This prevents device 10 from firing.When inner ring 142 of the second shift ring assembly is advanced, innerring 142 abuts inner ring 102 of the first shift ring assembly (if thefirst shift ring assembly is in the retracted position) to move thefirst shift ring assembly including inner ring 102 to its advancedposition. As discussed above, when inner ring 102 is moved to itsadvanced position, cam member 120 is moved within cam slot 56 a offiring pawl 56 to a position which permits O-ring 98 a to urge firingpawl teeth 56 b into engagement with teeth 52 of firing rack 48.

When firing trigger 20 is compressed in the grasper mode, barrelassembly 80 is moved proximally about spindle 30 to move firing rack 48proximally within guide track 32 of spindle 30. As firing rack 48 ismoved proximally, firing cable 410 is pulled proximally to partiallyadvance dynamic clamping member 309 distally in relation to anvil andcartridge assemblies 300 and 302 to approximate anvil and cartridgeassemblies 300 and 302. When firing trigger 20 is released, spring 188urges firing trigger 20 to its non-compressed position to return barrelassembly 80 to its advanced or distal-most position. Because grasperpawl finger 60 b is engaged in cutout 58 of firing rack 48, firing rack48 is moved distally with barrel assembly 82 to move dynamic clampingmember 309 proximally and return anvil and cartridge assemblies 300 and302 to the spaced position. Accordingly, firing trigger 20 can berepeatedly compressed and released to repeatedly move the anvil andcartridge assemblies between their spaced and approximated positions.The grasper made permits a surgeon to operate tool assembly as a grasperto facilitate the manipulation of tissue prior to operation of staplingdevice 10.

Referring to FIGS. 56-67, stapling device 10 is put in the firing modeby manually moving grasper buttons 22 proximally, in the directionindicated by arrow “G” in FIG. 56, along stationary handle portion 18.When grasper buttons 22 are moved proximally, inner ring 142 of thesecond shift ring assembly is moved proximally about barrel assembly 80to cam grasper pawl 60 out of engagement with cutout 58 in firing rack48 (FIG. 57). Prior to actuating firing trigger 20, indicator ring 68and extension 70, which are attached to retraction rack 50 are in theproximal-most position on spindle 30 (FIG. 58). Also, the first shiftring assembly, including inner ring 102, is retained in its advancedposition by engagement between nub 81 formed on body portion 82 ofbarrel assembly 80 and recess 81 a formed in inner ring 102.

When firing trigger 20 is actuated, barrel assembly 80 is movedproximally over spindle 30. Since firing pawl 56 is engaged with firingrack 48, firing rack 48 is also moved proximally along spindle guidetrack 32. As firing rack 48 is moved proximally, pinion 30, which isengaged with teeth 54 of firing rack 48 and teeth 64 of retraction rack50, drives retraction rack 50 distally within spindle guide track 34. Asfiring rack 48 is moved proximally, firing cable 410 is moved proximallyto pull dynamic clamping member 309 distally in relation to anvil andcartridge assemblies 300 and 302. Each actuation stroke of firingtrigger 20 advances dynamic clamping member 309 a predetermined amount,e.g., 15 mm. Accordingly, multiple actuation strokes of firing trigger20 may be required to advance dynamic clamping member 309 a distancesufficient to approximate the anvil and cartridge assemblies and tosequentially eject all of staples 334 from staple cartridge 332.

Referring to FIG. 64, when firing trigger 20 is released after eachactuation stroke, because of the angle of teeth 56 b of firing pawl 56,firing pawl 56 will ratchet over firing rack 48 as spring 188 (FIG. 65)returns firing trigger 20 and barrel assembly 80 to the unactuatedposition.

Referring to FIGS. 68-71, in order to retract dynamic clamping member309 to be able to move the anvil and cartridge assemblies to theirspaced position, shift lever 136 is pushed upwardly on firing trigger 20to pivot lever 108 about pivot member 131 a in the direction indicatedby arrow “H” in FIG. 70. This will move the first shift ring assemblyincluding inner ring 102 to the retracted position. As discussed above,when inner ring 102 is in the retracted position, cam member 120 urgesfiring pawl 56 to a position disengaged from firing rack 48 and cam 122is moved to a position within cam slot 66 a of retraction pawl 66 toallow O-ring 98 a to urge retraction pawl teeth 66 b into engagementwith retraction rack 50.

When firing trigger 20 is compressed or moved through an actuationstroke, barrel assembly 80 is moved proximally about spindle 30. Sinceretraction pawl 66 is engaged with retraction rack 50, retraction rack50 is moved proximally along guide track 34. Movement of retraction rack50 proximally rotates pinion 42 to drive firing rack 48 distally alongguide track 32. As discussed above, when firing trigger 20 is released,spring 188 urges firing trigger 20 back to its non-compressed positionto move barrel assembly 80 to its original non-fired position.Retraction pawl 66 ratchets over gear teeth when barrel assembly 80moves to its original position. Firing trigger 20 may have to be movedthrough multiple actuation strokes to fully retract dynamic clampingmember 309 and move anvil and cartridge assemblies 300 and 302 to theiropen position. As retraction rack 50 is moved proximally, retractioncable 412 is pulled proximally to pull dynamic clamping member 309proximally in relation to anvil and cartridge assemblies 300 and 302 tomove the anvil and cartridge assemblies to their open position.

It will be understood that various modifications may be made to theembodiments disclosed herein. For example, although the handle assemblyis disclosed to include a double ratchet assembly to both advance andretract the clamping member, other handle assemblies may also be used,e.g., handle assemblies which include manual pull return mechanisms maybe employed such as disclosed in U.S. Pat. No. 6,241,139, which isincorporated herein in its entirety by reference. Therefore, the abovedescription should not be construed as limiting, but merely asexemplifications of preferred embodiments. Those skilled in the art willenvision other modifications within the scope and spirit of the claimsappended hereto.

The invention claimed is:
 1. A surgical instrument comprising: anelongate portion defining a longitudinal axis and supporting a firstrotation knob and a second rotation knob, the elongate portion beingrotatable about the longitudinal axis upon manipulation of the firstrotation knob, the elongate portion having an inner tube and an outertube, the inner tube having a proximal portion and a distal portion; anda tool assembly having an anvil assembly, a cartridge assembly, a torquetransmitting member, and a dynamic clamping member, the tool assemblybeing disposed at an end of the elongate portion for independentrotation with respect to the elongate portion and for pivotal movementwith respect to the elongate portion; the second rotation knob havingteeth enmeshed with a gear, the gear being attached to the proximalportion of the inner tube of the elongate portion, the torquetransmitting member of the tool assembly being attached to the distalportion of the inner tube so that rotation of the second rotation knobrotates the inner tube within the outer tube to effect rotation of thetool assembly in relation to the outer tube.
 2. The surgical instrumentof claim 1, wherein the torque transmitting member is flexible to allowpivotal movement of the tool assembly.
 3. The surgical instrument ofclaim 1, further comprising a firing cable and a retraction cable. 4.The surgical instrument of claim 1, wherein the teeth of the secondrotation knob form an outer ring that is enmeshed with at least oneinternal pinion gear.
 5. A surgical instrument comprising: an elongateportion defining a longitudinal axis and supporting a first rotationknob and a second rotation knob, the elongate portion being rotatableabout the longitudinal axis upon manipulation of the first rotationknob, the elongate portion having an inner tube and an outer tube, theinner tube having a proximal portion and a distal portion; and a toolassembly having an anvil assembly, a cartridge assembly, a torquetransmitting member, and a dynamic clamping member, the tool assemblybeing disposed at an end of the elongate portion for independentrotation with respect to the elongate portion and for pivotal movementwith respect to the elongate portion; the second rotation knob havingteeth enmeshed with a gear, the gear being attached to the proximalportion of the inner tube of the elongate portion, the torquetransmitting member of the tool assembly being attached to the distalportion of the inner tube so that rotation of the second rotation knobrotates the inner tube within the outer tube to effect rotation of thetool assembly in relation to the outer tube; wherein the dynamicclamping member includes an upper flange portion and a lower flangeportion, the upper flange portion being positioned to engage the anvilassembly.
 6. The surgical instrument of claim 5, wherein the cartridgeassembly includes a channel support member supporting a staple cartridgeand the lower flange portion is positioned to engage the channel supportmember.
 7. The surgical instrument of claim 1, wherein the dynamicclamping member is movable through the tool assembly and engages thecartridge assembly and the anvil assembly to limit outward deflection ofthe anvil and the cartridge assemblies.
 8. A surgical instrumentcomprising: an elongate portion defining a longitudinal axis andsupporting a first rotation knob and a second rotation knob, theelongate portion being rotatable about the longitudinal axis uponmanipulation of the first rotation knob, the elongate portion having aninner tube and an outer tube, the inner tube having a proximal portionand a distal portion; a tool assembly having an anvil assembly, acartridge assembly, a torque transmitting member, and a dynamic clampingmember, the tool assembly being disposed at an end of the elongateportion for independent rotation with respect to the elongate portionand for pivotal movement with respect to the elongate portion; thesecond rotation knob having teeth enmeshed with a gear, the gear beingattached to the proximal portion of the inner tube of the elongateportion, the torque transmitting member of the tool assembly beingattached to the distal portion of the inner tube so that rotation of thesecond rotation knob rotates the inner tube within the outer tube toeffect rotation of the tool assembly in relation to the outer tube; anda firing cable and a retraction cable coupled to the dynamic clampingmember; wherein the dynamic clamping member is movable through the toolassembly and engages the cartridge assembly and the anvil assembly tolimit outward deflection of the anvil and the cartridge assemblies. 9.The surgical instrument of claim 1, wherein the torque transmittingmember includes a hollow bellows.
 10. The surgical instrument of claim1, wherein the torque transmitting member includes a coil spring. 11.The surgical instrument of claim 1, wherein the cartridge assemblyincludes a plurality of staples.
 12. The surgical instrument of claim11, wherein the staples of the cartridge assembly are arranged in linearrows.
 13. A surgical instrument comprising: an elongate portion defininga longitudinal axis and supporting a first rotation knob and a secondrotation knob, the elongate portion being rotatable about thelongitudinal axis upon manipulation of the first rotation knob, theelongate portion having an inner tube and an outer tube, the inner tubehaving a proximal portion and a distal portion; and a tool assemblyhaving an anvil assembly, a cartridge assembly, and a torquetransmitting member, the tool assembly being disposed at an end of theelongate portion for independent rotation with respect to the elongateportion and for pivotal movement with respect to the elongate portion;the second rotation knob having teeth enmeshed with a gear, the gearbeing attached to the proximal portion of the inner tube of the elongateportion, the torque transmitting member of the tool assembly beingattached to the distal portion of the inner tube so that rotation of thesecond rotation knob rotates the inner tube within the outer tube toeffect rotation of the tool assembly in relation to the outer tube. 14.The surgical instrument of claim 13, wherein the tool assembly includesa dynamic clamping member that is movable through the tool assembly, thedynamic clamping member engaging the cartridge assembly and the anvilassembly to limit outward deflection of the anvil and the cartridgeassemblies.
 15. The surgical instrument of claim 14, further comprisinga firing cable and a retraction cable coupled to the dynamic clampingmember.
 16. The surgical instrument of claim 13, wherein the torquetransmitting member includes a hollow bellows.
 17. The surgicalinstrument of claim 13, wherein the torque transmitting member includesa coil spring.
 18. The surgical instrument of claim 13, wherein thecartridge assembly includes a plurality of staples.